Background:
Obesity is a major public health threat to present and future generations. Conquering this national health crisis requires actions from all sectors of society, where youth and families live, work, and play.

In 2007, U.S. Senator Frist asked the GAO to prepare a report on physical inactivity and youth obesity. The GAO encouraged him to contact the YMCA of the USA (Y-USA) and as a result Stanford University wrote a report entitled: “Building Generation Play-Addressing the Crisis of Inactivity Among America’s Children.” This report offered more than 100 recommendations for all sectors of society. One of the recommendations was the development of a community index to assess opportunities for healthy eating and physical activity. The Institute of Medicine, in its report on Progress in Preventing Childhood Obesity (2006) also called for such an index suggesting a model that government supports a not-for-profit organization to partner with an academic institution to lead efforts dedicated to the prevention of youth obesity.

To fulfill these recommendations, the Y-USA collaborated with Stanford, Harvard, and St. Louis Universities, funded by the Centers for Disease Control and Prevention (CDC) to develop a Community Healthy Living Index (CHLI) that examines environmental and social supports for healthy eating and active living among youth and families. While other tools are available, CHLI provides the most comprehensive yet user-friendly means for community members to examine opportunities for healthy eating and physical activity across multiple venues. CHLI is a unique asset because it measures community programs, physical environment, promotion and policies, and also provides mechanisms for communities to take action to stimulate local changes for improvements.

Objectives:
This presentation will:

1. Describe the creation of a comprehensive community assessment tool to measure opportunities for healthy eating and active living.
2. Describe and encourage a process through which community members and institutions can mobilize to improve the health of their community.
3. Discuss Cognitive Response Testing (CRT) and inter-rater reliability of CHLI.
4. Provide comparative baseline data by community types (e.g., income, ethnicity, urban/suburban/rural).
5. Recommend strategies to improve local policies, practices, and environmental supports for healthy eating and physical activity.

Methods:
A comprehensive literature review and expert panel helped to determine the structure and implementation of CHLI. With YMCAs functioning as a convener, the survey and the recommended processes were pilot tested. Two communities tested the understandability of the questions, using CRT. Four new communities tested inter-rater reliability and the feasibility of implementing the index online. Lastly, participants evaluated the overall experience of the survey process. In September 2008, CHLI will become available to more than 300 YMCAs working with multi-sector partnerships in communities. Each community will enter data through the Y-USA online website; baseline data will be analyzed.

Results:
CHLI is composed of five sub-indices - school, afterschool, worksite, neighborhood, and community-at-large. A detailed administration guide was developed to help key stakeholders and representatives from various sectors of the community use the CHLI. This guide also describes the process by which team members can collaborate to create improvement plans in each venue. Immediately upon entering the survey data, teams receive feedback that describes their current status as one of five stages of development focused on celebrating accomplishments and encouraging sustainable changes. Communities are encouraged to repeat the CHLI process annually to monitor progress and celebrate success.

Initial questions were revised based on input from the CRT. Preliminary inter-rater reliability analysis (on all but the community-at-large sub-index) indicates that 89% of the questions showed substantial to almost perfect agreement (60% and above) between raters. For example, in the school survey, 83% of items showed agreement between raters greater than 75% and 89.5% of items had agreement above 60%. In terms of stage of development, for example, 83% of the work site surveys showed an agreement.

Data from communities participating in CHLI starting September 2008 will be analyzed and will serve as the basis for the presentation. Data will reflect communities of different sizes and socio-economic status. In addition, community strategies for improvement will be shared.

Conclusions:
At the local level CHLI draws attention to issues that contribute to obesity and creates impetus for change. Implementation of CHLI will enable communities to identify gaps and implement changes that can improve opportunities for healthy eating and physical activity. A national database will provide compelling support for a federal agenda aimed at community strategies to reduce childhood obesity.

Support:
This project was funded by the CDC. CHLI was made possible by the enthusiastic contribution of the Expert Panel, the pioneering effort undertaken by the local YMCAs that participated in the project’s pilot phases, and the Y-USA’s leadership and commitment to the prevention of childhood obesity. For the bulk of research, Dr. Brownson was at St. Louis University, and Dr. Wiecha was at Harvard University.